THE USE OF PARAGLOSSAL STRAIGHT BLADE LARYNGOSCOPY IN DIFFICULT TRACHEAL INTUBATION

In 10 cases of unexpected difficult tracheal intubation using the Maci ntosh laryngoscope blade, the larynx could not be seen. In each case, a good view was achieved using the Miller blade lateral to the tongue, which enabled tracheal intubation under direct vision. The results ac hieved using narrow, low-profile straight laryngoscope blades with thi s technique are reviewed. The improved view obtained with this techniq ue is a consequence of reduced tongue compression as compared with the Macintosh technique. This leads both to an improved line of sight, an d to a reduced risk of backward displacement of the tongue and epiglot tis. In addition, the molar or retromolar variation of the technique r educes the intrusion of maxillary structures into the line of sight, s o that a better view of the larynx is achieved for a given degree of s oft tissue compression. Paraglossal straight blade laryngoscopy may ha ve an advantage over use of the Macintosh technique when intubation pr oves unexpectedly difficult. It is perhaps time to question standard t eaching about the role of the curved blade in such patients or, more p articularly, whether the technique of laryngoscopy as currently taught is optimal. The paraglossal straight blade technique needs to be prac tised in routine intubation before it can be used with confidence in d ifficult cases.